Wednesday, 26 October 2011

Privatisation

Privatisation refers to transfer of ownership and control of government or state assets, firms and operations to private investors.

At the RCGP conference this year Andrew Lansley was asked to define privatisation. He gave two definitions. After being challenged by Dr Clare Geralda Lansley gave the follwoing (his second definition):

Privatisation is the transfer of public service responsibilities into the private sector - we are not transferring responsibility for the NHS into the private sector.

This is not the OECD definition, who say that it is the transfer of the ownership of assets as well as the control of those assets. Lansley talks about the responsibility for the NHS which is a much wider issue. The government/NHS Commissioning Board can still be responsible for the NHS even if all the assets are owned by the private sector, because in Lansley's mind the NHS is the source of the money to pay for treatment: the taxpayer.

This brings me onto the first definition that Lansley gave:

As far as the public are concerned, privatisation would mean - if you would ask them - having to pay for their care instead of receiving that care provided by the NHS free-at-the-point-of-use based on their need. We are not going to move to a place where there is any additional payment.

Again, this is very different to the OECD definition, which says nothing about how services are funded.

(1) A clinical commissioning group [CCG] must arrange for the provision of the following to such extent as it considers necessary to meet the reasonable requirements of the persons for whom it has responsibility— (a) hospital accommodation, (b) other accommodation for the purpose of any service provided under this Act, (c) medical, dental, ophthalmic, nursing and ambulance services, etc

Currently the Secretary of State determines what services will be funded by the NHS, Lansley does not want this responsibility and so it will be local Clinical Commissioning Groups who will decide. The CCGs will decide based on the amount of funding they have - if they do not have enough money they may have to prioritise urgent care and may decide that services that are less "medical" should be paid for by the patient. For example hospital "hotel services". A CCG could argue that if you were not in hospital you would be paying for food and accommodation, they could argue that "hotel services" are not a medical need and so you should have to pay for them when you are admitted to hospital. This argument has been made for many years, but it is usually opposed by arguing that without the "hotel services" the patient cannot get the treatment.

Under Lansley's very restricted definition of privatisation, "having to pay for their care" such a charge for "hotel services" would be privatisation. When such charges are imposed (and they will be, somewhere in the country in the next few years) I wonder if Lansley will admit that the NHS in that area have been "privatised"?

Further, note the statement "we are not going to move to a place where there is any additional payment". This is happening now! The doctorpreneur GPs in Haxby told their patients that the NHS would no longer fund certain treatments (as CCGs will be able to do in the future) and then gave the patients a price list for having the treatment carried out privately additional payments for care. So under Lansley's definition privatisation has already happened in Haxby.

Update:
The question about privatisation (with a reference to Bill Clinton and cigars) from Dr Pete Deveson can be found here (at 9:38). Lansley responds to the question with a disdainful shake of the head.